HEALTH INSURANCE TERMS TO KNOW FOR BETTER HEALTH CARE
It is easy to be confused by health insurance. From choosing a plan that fits your budget to figuring out exactly how much you need to spend out-of-pocket for medical treatments, it can be difficult to wrap your head around health care.
The Affordable Care Act should help make health insurance more accessible and understandable. The law, however, has introduced new provisions with terms and concepts that you have to be familiarized with.
Here are some terms that will help you better understand health insurance and get the health care you need:
AFFORDABLE CARE ACT
The Patient Protection and Affordable Care Act, often shortened to the Affordable Care Act, colloquially known as “Obamacare,” is a federal statute signed into law by President Barack Obama in 2010. The law significantly regulates healthcare system of American and expands its coverage. Certain provisions of the Affordable Care Act have already been put in place. Other provisions will be made available in the coming years.
AFFORDABLE INSURANCE EXCHANGE
A platform which offers health insurance plans to individuals, families, or small businesses. This is sometimes referred to as the health insurance marketplace. The Affordable Care Act established these exchanges or the marketplace as a means for all Americans to learn about health insurance coverage options that suit their income. Being able to compare different health insurance plans allows these people or businesses to choose one that best fits their needs. Many states offer their own exchanges or marketplaces, but it also exists at the federal level.
CANCELLATIONS
A provision in your health insurance policy that permits an insurance company to cancel your health coverage before its expiration date. This usually happens if you knowingly falsified or omitted information on your application. The Affordable Care Act prohibits cancellations due to making a mistake on your application.
CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT GIVES (COBRA)
The Consolidated Omnibus Budget Reconciliation Act gives you and your family the right to choose to temporarily continue with the group health insurance plan provided by your employer even after you voluntarily or involuntarily leave a job, reduce your hours, or transition between jobs.
COPAYMENTS
A payment that you must make as a beneficiary for health care services in addition to the payment made by the insurer. This fixed amount is often $15 or $20 and is paid out of pocket.
DEDUCTIBLE
The specified amount of money that you must pay out of pocket before an insurance company will pay a claim for your medical expenses. Health insurance plans with higher deductibles generally have lower premiums.
DEPENDENT COVERAGE
Insurance coverage provided by insurance plans for family members of the policyholder, such as spouses, children, or partners. A provision under the Affordable Care Act allows you to add or keep dependent coverage for children on your health insurance plan until they reach the age of 26.
DRUG FORMULARY
A list of medicines specifying all the medication covered under your health insurance plan.
ESSENTIAL HEALTH BENEFITS
An essential health benefit is health insurance or an insurance plan that comes with a set of benefits for individuals or small group of people. These essential health benefits are a list of different medical services that include emergency services, prescription drugs, hospitalization, maternity and newborn care, and care for mental health and substance use disorders.
GRANDFATHERED HEALTH PLANS
An individual health insurance plan purchased on or before March 23, 2010. These plans were not sold through the Marketplace. These plans may not include some of the provisions under the Affordable Care Act.
HEALTH CARE PLAN CATEGORIES
If you buy health insurance from the Marketplace, each insurance provider may offer health care plans belonging to one of these four common categories: bronze, silver, gold, or platinum. Deductibles and coverages differ according to the plan. Bronze plans offer the least coverage, and platinum plans offer the most.
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
The Health Insurance Portability and Accountability Act is a federal law that requires health insurance companies to safeguard medical information. The law standardizes and modernizes the handling of personally identifiable information, protecting it from theft and fraud. It also addresses certain limitations of healthcare insurance coverage.
INDIVIDUAL MANDATE
A requirement by law imposed on most individuals and their families to buy a certain minimal amount of health insurance.
LIFETIME LIMITS
A dollar limit on what insurance companies spend on health benefits over your lifetime. The Affordable Care Act provides protections against lifetime limits for essential health benefits. As of 2014, insurance companies can’t set yearly limits on what they spend for your coverage, either.
MEDICAID EXPANSION
A provision in the Affordable Care Act expanding eligibility for Medicaid to cover people with low incomes and people with disabilities. The government has funded most of the cost for the expansions.
MENTAL HEALTH PARITY ACT (MHPA)
The Mental Health Parity Act is a legislation that requires health insurance plans to provide coverage for mental health concerns that is equivalent to coverage for physical health problems
MINIMUM ESSENTIAL COVERAGE
The type of health insurance policy an individual must have to meet the health coverage required under the Affordable Care Act. If you do not meet or maintain minimum essential coverage, you may have to pay a penalty.
PRE-EXISTING CONDITION
A medical condition that already existed before a person’s health benefits went into effect. Since 2014, the Affordable Care Act has prohibited insurance companies from excluding expenses due to pre-existing conditions.
PREMIUM
The amount of money an individual or business must pay for a health insurance. Monthly, quarterly, or yearly payment options are available.
PREVENTIVE SERVICES
Services that include screenings, checkups, and counselling to prevent health-related problems. The Affordable Care Act requires that your health insurance plan provides 100 percent coverage for preventive services.
SPECIAL ENROLLMENT
Joining or changing a health insurance marketplace plan even if the open enrollment period is over due because of some certain life events. Life changes that qualify you to opt for a special enrollment include getting married, having or adopting a baby, getting legally separated from a spouse and losing health insurance, and changing residence.
SUMMARY OF BENEFITS AND COVERAGE
A summary of your health insurance plan’s benefits and coverages that is easy for you to understand. The Affordable Care Act requires that the insurer provides you with this summary.
TAX CREDIT PREMIUM AND ADVANCED PREMIUM
A federal tax credit for individuals to get discounts on their monthly premium payments for their insurance. Eligible recipients of the tax credit receive an amount determined by the recipient’s income. This helps you afford health coverage when you buy health insurance from the Marketplace.
Based on Materials from Health
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